AB0299 THE RISK OF ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS IS COMPARABLE TO THE GENERAL POPULATION IN THE TREAT-TO-TARGET ERA
Authors: W. Bian, Y. Hao, H. Huang, W. Xie, Y. Wang, X. Deng, Y. Geng, L. Ji, X. Zhang, J. Zhao, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with rheumatoid arthritis (RA) suffer form an increased cardiovascular disease (CVD) risk compared with the general population. This is due to the fact that systemic inflammation not only accelerates the progress of RA but also promotes the development of atherosclerotic plaque.<sup>[1]</sup> Intima-media thickness of the carotid artery (cIMT) is considered as a reliable marker of the presence and the burden of atherosclerosis.<sup>[2]</sup> Since the treat-to-target (T2T) strategy was first introduced into RA management in 2010, it has been widely proved that patients treated with an underlying T2T strategy could obtain clinical remission more rapidly and achieve higher clinical remission rates<sup>[3]</sup>. However, what's the effect of a better controlled disease on the development of atherosclerosis? <h3>Objectives</h3> To compare the prevalence and incidence of carotid atherosclerosis monitored by ultrasound between patients with RA treated guided by a T2T strategy and age, gender-matched healthy controls, as well as identify risk factors of atherosclerosis aggravation among RA patients. <h3>Methods</h3> We used data from a longitudinal prospective cohort of RA patients and a community-based atherosclerosis cohort in the general population. Age and gender-matched participants were picked up by propensity score matching to be compared in their clinical characteristics and the process of atherosclerosis. And then a comparison was made according to the traditional CVD risk factors and RA-related factors between RA patients with carotid atherosclerosis progress (CAP) and without. A Cox proportional hazards regression model was operated to find out the risk factors of carotid atherosclerosis progress in the patients with RA. <h3>Results</h3> A total of 182 patients with RA were included. After a median 28 months of follow-up, 91.76% of patients reached remission or low disease activity target. The mean (or median) cIMT in RA patients was increased significantly after the follow-up, and 39 participants were recognized as CAP. Age at entry (HR 1.095, 95% CI 1.043, 1.149, P&lt;0.001) and time adjusted body mass index (HR 1.127, 95% CI 1.011, 1.257, P=0.030) were identified by the multivariate Cox regression hazard model as the independent risk factor of carotid atherosclerosis progress for this group of RA patients. The prevalence of carotid atherosclerosis between 80 RA patients and 400 age, gender-matched controls, was compared, and no significant difference was found, no matter at the baseline (52.50% vs 49.67%, P=0.652)(Figure 1A) or the endpoint of the follow-up (53.75% vs 54.75%, P=0.870)(Figure 1B). The incidence of carotid atherosclerosis during the follow-up between 50 RA patients and 50 age, gender, and BMI- matched controls was also comparableb(28.00% vs 28.00%, P=1.0)(Figure 1C). <h3>Conclusion</h3> Compared with the general population, the patients with RA treated adhering to a T2T strategy presented with a similar incidence and prevalence of atherosclerosis. Among disease well-controlled RA patients, RA-related factors have little impact on the carotid atherosclerosis progress. <h3>References</h3> [1] Del Rincón I, Williams K, Stern MP, Freeman GL, O'Leary DH, Escalante A. Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthritis Rheum. 2003;48(7):1833-1840. [2] Bots ML, Grobbee DE. Intima media thickness as a surrogate marker for generalised atherosclerosis. Cardiovasc Drugs Ther. 2002;16(4):341-351. [3] Brinkmann GH, Norvang V, Norli ES, et al. Treat to target strategy in early rheumatoid arthritis versus routine care - A comparative clinical practice study. Semin Arthritis Rheum. 2019;48(5):808-814. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.